Post on 21-Feb-2018
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GLOBAL ISSUES IN WATER, SANITATION & HEALTH
The Spectrum of
Water-Related Disease
Transmission Processes
David BradleyLondon School of Hygiene & Tropical Medicine and
Department of Zoology, University of Oxford
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DISEASE TRANSMISSION PROCESSES
1. Revisit critically the classification of W& S disease transmission processes.
2. Suggest unsystematized areas needing
attention, including behaviour, andprocesses in space and time
3. Use a small area of SW Uganda to show
the inter-related complexities andresearch issues.
A Waters-Eye View
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Social Uses of Classificationsl Bringing order & Clarity to thought
l Shining lights in dark corners
l To make explicit the assumed
[that may be less applicable elsewhere]
Eg health needs ACCESS to water
Water is not just for drinking
l Analogy with research is that:Draw attention to possible new data
Give validity and credibility to an area
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What is the function of a
Classification?
l Classification is a qualitative model of
distinctions that matter
l A means of (trans-sectoral) communication,
especially as water improvements are very
largely implemented outside the health sector
l A simplification to help public healthpractitioners
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WATER RELATED DISEASE CLASSIFICATION
1. WATER-BORNE
2. WATER-WASHED
3. WATER-BASED
4. WATER-RELATED
INSECT VECTORS
-Classical
-Other
-Diarrhoea
-Skin & Eyes
-Percutaneous
-Oral-Breeding
-Biting
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WATER RELATED DISEASE CLASSIFICATION
5. WATER-AEROSOL
TheLegionellapattern of transmission does
not fit well into any of the four existing
categories, which are defined by how the
diseases are contracted. None of the othersrelates to intake via the respiratory tract
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WATER RELATED DISEASE CLASSIFICATION
l WATER-BORNE
l WATER-WASHED
l WATER-BASED
l WATER-RELATED
INSECT VECTORS
-Classical
-Other
-Diarrhoea
-Skin & Eyes
-Percutaneous
-Oral-Breeding
-Biting
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COMPARATIVE FINDINGS OF THE TWO
Drawers of WaterSTUDIES
Water Use in Litres / Person / Day; 30 Years Apart
DOW I DOW II
Piped Urban 128 66.0 Down, Halved
Unpiped Urban 15.4 23.7 Up, By Half
Unpiped Rural 9.7 18.3 Up, Doubled
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WATER RELATED MODE OF DISEASE
TRANSMISSION CLASSIFICATION
l WATER-WASHED
Diarrhoea
Skin
Eyes: Trachoma
? Waterwashed Respiratory
Infections
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WATER RELATED DISEASE CLASSIFICATION
l WATER-BORNE
l WATER-WASHED
l WATER-BASED
l WATER-RELATED
INSECT VECTORS
-Classical
-Other
-Diarrhoea
-Skin & Eyes
-Percutaneous
-Oral-Breeding
-Biting
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CLASSIFICATION OF DISEASES
RELATED TO SANITATION
Excreted Load
LATENCYPERSISTENCE
MULTIPLICATION
Infective Dose
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Categories of Transmission by Excreta
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DISEASE TRANSMISSION RELATED TO SANITATION
# Lat. Persist Mult. Biology Focus Examples
I No Short No V,Pr,He Pers,Dom Rotavirus
Enterobius
II No Longer Yes Bact P,D,W Typhoid
Cholera
III Yes Long No Helm Field,C Ascaris
Hookworm
IV Yes [Long] Cow/PigHelm Field Taenia saginata
Taenia solium
V Yes [Long] Aquatic Helm Water Paragonimus
Schistosoma
VI Spread by excreta-related insects Some mosq. Wuchereria
Flies. Cockroaches:several above
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DISEASE TRANSMISSION RELATED TO SANITATION
l The categories feed into sanitary barriersl Give a sense of where control best:
Personal hygiene behaviour
Domestic water supply
Provision of toilets Treatment of Excreta
Specific measures (e.g. cooking fish)
l Close to biology (closer than for Water-related)
l
Levels of Action: Person Personal Handwashing Household. Toilet Provision
Community Sewage Treatment
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Where to next?
l Limitations of Strengths Speak to engineers; but they cannot provide the whole
solution
Show needs for behaviour change
Greater complexity of Rural and Periurban SitesAGENDA ITEM:
l Systematization of Hygiene Behaviour
Handwashing with soap !!!
Mechanisms for respiratory disease benefits ?Handling childrens excreta
Behavioural aspect of the plateau, etc. etc.
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Spatial Processes
In Control and in Service Provision
l Periurban complications for interventions.
l
Private Space & Public Space (Cairncross)e.g. Who constructs & who maintains?
l Successive circles of Space (Kolsky)
In Disease Persistence and Emergencel The 4 tsetse and 75% sleeping sickness
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GLOBAL ISSUES IN WATER, SANITATION & HEALTH
l Global has several components
Affects whole world together (e.g. global warming)
Universal, affecting everyone in same way.
Affects many people: small scale but relicated verymany times but there are local variations; one size
in practice does NOT fit all.
A local happening whose consequences affect
many; e.g. a human transmissible avian flu emerges
l Back to Global Threats; cf Global Endemics
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Spatial Processes
In Disease Persistence and Emergence
l Small populations sharing polluted water sources
l Untidy species-rich neglected water sites
l Recurrent motifs in water morphologyl Consequential reservations
l Ecotones
l Shared spaces between species: People, Livestock,
Wildlife
l Chronotones: Periods of massive change that can be
an opportunity
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Spatial Processes
In Disease Persistence and Emergencel Small populations sharing polluted water sources
l Untidy species-rich neglected water sites
l Recurrent motifs in water morphologyl Consequential reservations
l Ecotones
l Shared spaces between species: People, Livestock,
Wildlife
l Chronotones: Periods of massive change that can be
an opportunity
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Mooya Ifura
Ntuura
Rwabarata
Akatongore
Byanamira
Embale
Kaitanturegye
Kanya
ryeruR
esSchem
e
Kasaana
Kayonza
Macuncu
Mooya
Nyakasharara
RugongiRwemamba
Rwe
njubu
RwetamoRwetamo
Rwe
njubu
Rwemamba
Kaky
eera
Rugongi
Nyakasharara
Nyakahita
Mooya
Macuncu
Kasaana
Kaitanturegye
Rugaaga
Embale
Byanamira
Rwetamo
Rwe
njubu
RwemambaRugongi
Nyakasharara
Mooya
Macuncu
Katooma
Kasaana
Kaitanturegye
Embale
Byanamira
Mugore
Kiribw
a
20 0 20 40 Miles
Mapsima.shp# Mapofnyabushozi villages.shp
landuse
# boarderKakyeera# LCI# brick burning# centre
# charcoal burning homestead (P)$Z homestead (S)
%[ homestead (T)
# kakyeera centre
# kraal
# lake
# plantation# pond# swamp# village
N
EW
S
Map of Nyabushozi County showing the study area
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To bring alive the integrated nature of water problems:
l Consider settling nomadic pastoralists in SW Uganda On settling, water problems and malaria got worse
?deviation of An. Arabiensis to children as less available cattle? No
Privatized land without water planning first
Cut people off from usual water bodiesNeed more reliable sources if no migration
Everyone digs own farm ponds: moreAn. gambiae
People share the water sources of the cows
National Park lake is water source of last resort for them Ugandas good water policy & poverty policy not designed
to cope with this.
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Water, Sanitation & Health Agendas
l Blue Agenda of water availability fordomestic and agricultural needs.
l Brown Agendawith sanitary goal.
l Green Agendaof environmentalsustainability, biodiversity.
l Red Agendaof less vector-borne
disease.l Purple Agendaof less non-biological
pollution.
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Some Research Implications
l Need for analytical classification of
Behavioural aspects of W & S, including work on
perception of water as a basis for both changes towards
healthy behaviour and to multisectoral policies.
Water interactions in both conceptual and actual spacein relation to both disease emergence and disease
control
l Need for Long-Term Longitudinal Field Studies
Biological as well as Mathematical Process Modelling
Both in Laboratory and by field studies
Build up integrated bodies of locally relevant
interdisciplinary knowledge
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Acknowledgements
Ross Institute, LSHTM
Sandy Cairncross
Richard Feachem
Pete Kolsky
Tom Clasen
Valerie Curtis
Sylvia Struck
Sanga Project, Uganda
Joseph Okello- Onen
Charles Muchunguzi
and many others
Drawers of Water I & II
Gilbert F White
Anne U White
John Thompson
Mark Mujwahuzi
Munguti Katui-Katua
James Tumwine
Also
Hemda Garelick
Duncan Mara
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